Rationale: Published pneumonia treatment guidelines recommend performance of blood cultures for all inpatients to optimize therapy. Improved survival has been associated with optimal therapy. In addition, the yield of clinically useful information is greater if the culture is collected before antibiotics are administered.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Number of pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics

Denominator Statement: Pneumonia patients 18 years of age and older who have an initial blood culture collected as an emergency department patient.

Included Populations:
Discharges with:

An ICD-9-CM Principal Diagnosis Code of pneumonia as defined in Appendix A, Table 3.1 OR ICD-9-CM Principal Diagnosis Code of septicemia or respiratory failure (acute or chronic) as defined in Appendix A, Tables 3.2 or 3.3 AND

An ICD-9-CM Other Diagnosis Code of pneumonia (Appendix A, Table 3.1)

Excluded Populations:

Patients less than 18 years of age

Patients who have a Length of Stay >120 days

Patients with Cystic Fibrosis (Appendix A, Table 3.4)

Patients who had no chest x-ray or CT scan that indicated abnormal findings within 24 hours prior to hospital arrival or anytime during this hospitalization

Patients with Comfort Measures Only documented day of or day after arrival

Patients enrolled in clinical trials

Patients received as a transfer from the emergency department of another hospital

Patients who have a final diagnosis/impression of pneumonia upon direct admit

Patients who had no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression

Patients who only received antibiotics prior to hospital arrival

Patients who do not receive any antibiotics within 24 hours after arrival.

Patients who do not receive a blood culture

Patients who do not have a blood culture collected in the ED prior to admission order

Patients who have a blood culture collected within 24 hours prior to hospital arrival

Patients discharged/transferred to another hospital for inpatient care on day of or day after arrival

Patients discharged/transferred to a federal health care facility on the day of or the day after arrival

Patients who left against medical advice or discontinued care on day of or day after arrival

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-9-CM diagnosis and procedure codes, which require retrospective data entry.

To be part of the measure population, a patient must have received an antibiotic either during the hospitalization or within 24 hours prior to hospital arrival plus during the hospitalization. Measure specifications do not require documentation of the exact date and time of the antibiotic taken prior to hospitalization.

To be part of the measure population, a patient must be an Emergency Department patient and have a blood culture collected prior to an admission order.